Healthcare Provider Details

I. General information

NPI: 1780251249
Provider Name (Legal Business Name): KRISTIN BEMIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 LAKE SAINT LOUIS BLVD SPC 219
LAKE SAINT LOUIS MO
63367-2923
US

IV. Provider business mailing address

408 MASON CREEK DR
LAKE SAINT LOUIS MO
63367-4260
US

V. Phone/Fax

Practice location:
  • Phone: 636-236-5431
  • Fax:
Mailing address:
  • Phone: 636-236-5431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2021042209
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: